Atopic dermatitis is the most common chronic inflammatory skin disease in children. It usually develops in infancy and early childhood and is an entry point of 'atopic march', which may progress to other allergic diseases, including allergic rhinitis and asthma. Although there is no disagreement on the importance of early treatment of atopic dermatitis, it is difficult to treat children with moderate to severe atopic dermatitis due to concerns about treatment-related side effects and age restrictions for effective drugs in real world. As recent researches have extend our understanding of pathogenesis, new agents targeted key pathologic mechanisms have been developed. Therefore, it is time to establish a new paradigm of treatment for children with atopic dermatitis since new biologics have been demonstrated to be effective and safe in children. The objective of this article is to review the clinical characteristics, severity classification, pathogenesis, and treatment, in particular, biologics already approved/undergoing clinical trials for children with atopic dermatitis. (Allergy Asthma Respir Dis 2021;9:59-68)

Purpose: Survivors of preterm birth are at high risk of chronic pulmonary disease. We examined lung function in the school-age children born preterm and investigated the relationship between lung function and clinical parameters.
Methods: Thirty children born preterm were enrolled and divided into 2 groups: 14 very preterm (<32-week gestational age [GA]) and 16 moderate-to-late preterm (32- to 36-week GA). Pulmonary function tests (PFTs) were performed repeatedly during school-age and PFT parameters were compared with age-matched controls. The relationship between PFT and clinical parameters was also studied.
Results: PFT parameters in the very preterm group were persistently reduced compared with age-matched controls (P<0.05). Half of the children had been diagnosed with asthma at the visit for the first PFT. Seventy-seven percent of patients in the very preterm group had bronchial hyperresposiveness. Birth weight, duration of oxygen therapy and mechanical ventilation in the neonatal intensive care unit, and body weight at age 1 were associated with forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), or forced expiratory flow between 25% and 75% of expired vital capacity (FEF25%-75%) z-scores. Multiple regression analysis revealed that body weight at age 1 was an independent predictor of FEV1 and FVC z-scores, and duration of oxygen therapy was independently associated with FEF25%-75% z-scores (P<0.01 for all).
Conclusion: No catch-up in lung function was observed in school-age children born very preterm. Lower body weight at age 1 might be an independent risk factor for reduced FEV1 and FVC, whereas long-term oxygen therapy might be associated with reduced FEF25%-75%. (Allergy Asthma Respir Dis 2021;9:69-75)

Purpose: Asthma is a common chronic lung disease, in which interleukin (IL)-13 is implicated as a central regulator of IgE synthesis, mucus hypersecretion, airway hyperresponsiveness (AHR), and fibrosis. This study was designed to determine the anti-inflammatory effect of atorvastatin, a widely used lipid-lowering agent, on the IL-13-induced lung pathology through the modulation of macrophages.
Methods: Atorvastatin (40 mg/kg) was given to transgenic mice overexpressing IL-13 (IL-13 TG mice) and their wild type littermates by oral gavage for 2 weeks. AHR, numbers of inflammatory cells in the airway, and cytokine levels in IL-13 TG mice were measured. Using the alveolar macrophage cell line CRL-2456, the direct effect of atorvastatin on macrophages activated by recombinant IL-13 was assessed.
Results: Significant reduction in total leukocytes and alleviation of AHR were observed with administration of atorvastatin in IL-13 TG mice compared to those without atorvastatin treatment (P<0.05). Atorvastatin administration resulted in upregulation of IL-10 in the lungs of IL-13 TG mice (P<0.05). In addition, mRNA expression of connective tissue growth factor, fibronectin, and type III collagen as well as chord length enhanced by IL-13 overexpression were reduced by atorvastatin administration (P<0.05). M2 macrophage markers, such as Ym-1 and CD206, were decreased, while M1 macrophage marker, inducible nitric oxide synthase, was increased upon atorvastatin treatment (P<0.05). Administration of atorvastatin resulted in improved removal of apoptotic cells (P<0.05).
Conclusion: The results of this study reveal a potential of atorvastatin as an effective antiasthmatic agent by reducing IL-13-induced lung inflammation via the modulation of macrophage polarization. (Allergy Asthma Respir Dis 2021;9:76-83)

Purpose: Contrast media is one of the most common cause of adverse drug reaction (ADR) in adult. However, there was little data reported about differences in ADR ratio and severity among iodinated contrast media (ICM).
Methods: Medical records of 627,049 patients who performed computed tomography scan using low-osmolar nonionic iodinated contrast media from January 2015 to December 2018 were retrospectively reviewed. A total of 6 ICMs including iomeprol, iohexol, iopromide, iobitridol, ioversol, and iopamidol were used in this period. The incidence of ADR was compared to their total usage and dosage between each contrast media.
Results: The incidence of ADR of iopromide (1.36%) and iomeprol (1.27%) was the highest when compared with the average incidence of 1% of 6 ICMs. Ioversol (0.67%), iohexol, and iobitridol (0.74%) had the lower incidence of ADR. The order of results adjusted by actual administered dosage, the use of premedication, and the prior exposure history of ICMs was similar. The fraction of moderate and severe ADR in overall ADR was slightly different, but not proportional to the incidence of ADR.
Conclusion: The incidence of ADR among 6 low-osmolar nonionic ICMs was significantly different when compared by the total number of usage and the total volume of dose. The incidence of ADR varied by nearly 2-fold depending on ICMs. Further study might need to explore the reason for the difference of incidence. (Allergy Asthma Respir Dis 2021;9:84-92)

The Sézary syndrome is a leukemic form of cutaneous T-cell lymphoma characterized by the presence of erythroderma covering at least 80% of the body-surface area, lymphadenopathy, and the presence of clonally related neoplastic T cells with cerebriform nuclei (Sézary cells) in the blood, skin, and lymph nodes. Hypereosinophilia can be caused by hematologic malignancy with clonal abnormality, which is often associated with Sézary syndrome. Sézary syndrome has rarely been reported in Korea. However, hypereosinophilia in the Sézary syndrome has not been reported in Korea. Here, we report a case of 75-year-old man with hypereosinophila, erythroderma, and cutaneous T-cell lymphoma which was finally diagnosed as Sézary syndrome. (Allergy Asthma Respir Dis 2021;9:93-98)

Povidone, also known as polyvinylpyrrolidone has high sterilizing power and low toxicity, and has been widely used in disinfectants, ointments, gels, shampoos, soap, and pharmaceutical tablet additives. Povidone-iodine (Betadine) is a rare cause of IgE-mediated allergy, and to our best of knowledge there have been no reports in Korea. We report the first case of anaphylaxis in Korea presumably caused by a trace amount of povidone contained in a tablet pill. An 18-year-old man experienced severe rhinorrhea, nasal congestion, eyelid swelling, cough, and dyspnea after taking multiple drugs at the same time for abdominal pain and diarrhea 20 days before the hospital visit. Symptoms disappeared after the treatment. He experienced similar symptoms after applying povidone to skin wounds 2 years ago. Among the drugs taken, these symptoms were assumed to be caused by a drug containing a trace amount of povidone. The remaining drug was tested by oral provocation, and there were no adverse reactions. He has avoided drugs containing povidone and has not experienced similar reactions for more than 1 year since then. Therefore, it is presumed that a systemic hypersensitivity reaction may occur due to a very small amount of povidone in a tablet pill. (Allergy Asthma Respir Dis 2021;9:99-103)

Cytomegalovirus (CMV) is the most common agent of congenital infections and opportunistic infections in an immunocompromised host. CMV in an immunocompetent host has inapparent infections, which are usually asymptomatic or cause mild mononucleosis-like symptoms. However, severe CMV diseases, such as pneumonia, hepatitis, gastrointestinal disease, often occur in a healthy infant. The association of CMV pneumonia with the development of pneumothorax has rarely been reported. We experienced a case of CMV pneumonia presenting as pneumothorax in a 4-month-old healthy infant, who was successfully treated with supportive care. CMV was confirmed by using CMV polymerase chain reaction of tracheal aspirates. This case suggested that CMV should be considered as a cause of viral pneumonia during the infant period. (Allergy Asthma Respir Dis 2021;9:104-108)

Lipid transfer protein (LTP) is a widely cross-reacting allergen in vegetables, fruits, nuts, or cereals. The amino acids sequence of LTP shows high structural similarity in various foods and thus acts as a pan-allergen. LTP syndrome is a new term for the pattern of clinical symptoms and natural course of allergy caused by LTP antigens. It is frequently reported by peaches mainly in the Mediterranean region, and reports in East Asia are rare. Therefore, this case report introduces a 36-year-old female Asian who experienced recurrent anaphylaxis and oral allergy syndrome, and finally diagnosed with LTP syndrome. (Allergy Asthma Respir Dis 2021;9:109-112)